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De-implementation of low value castration for men with prostate cancer: protocol for a theory-based, mixed methods approach to minimizing low value androgen deprivation therapy (DeADT)
- Source :
- Implementation Science : IS, Implementation Science, Vol 13, Iss 1, Pp 1-11 (2018)
- Publication Year :
- 2018
-
Abstract
- Background Men with prostate cancer are often castrated with long-acting injectable drugs termed androgen deprivation therapy (ADT). Although many benefit, ADT is also used in patients with little or nothing to gain. The best ways to stop this practice are unknown, and range from blunt pharmacy restrictions to informed decision-making. This study will refine and pilot two different de-implementation strategies for reducing ADT use among those unlikely to benefit in preparation for a comparative effectiveness trial. Methods/design This innovative mixed methods research program has three aims. Aim 1: To assess preferences and barriers for de-implementation of chemical castration in prostate cancer. Guided by the theoretical domains framework (TDF), urologists and patients from facilities with the highest and lowest castration rates across the VA will be interviewed to identify key preferences and de-implementation barriers for reducing castration as prostate cancer treatment. This qualitative work will inform Aim 2 while gathering rich information for two proposed pilot intervention strategies. Aim 2: To use a discrete choice experiment (DCE), a novel barrier prioritization approach, for de-implementation strategy tailoring. The investigators will conduct national surveys of urologists to prioritize key barriers identified in Aim 1 for stopping incident castration as localized prostate cancer treatment using a DCE experiment design. These quantitative results will identify the most important barriers to be addressed through tailoring of two pilot de-implementation strategies in preparation for Aim 3 piloting. Aim 3: To pilot two tailored de-implementation strategies to reduce castration as localized prostate cancer treatment. Building on findings from Aims 1 and 2, two de-implementation strategies will be piloted. One strategy will focus on formulary restriction at the organizational level and the other on physician/patient informed decision-making at different facilities. Outcomes will include acceptability, feasibility, and scalability in preparation for an effectiveness trial comparing these two widely varying de-implementation strategies. Discussion Our innovative approach to de-implementation strategy development is directly aligned with state-of-the-art complex implementation intervention development and implementation science. This work will broadly advance de-implementation science for low value cancer care, and foster participation in our de-implementation evaluation trial by addressing barriers, facilitators, and concerns through pilot tailoring. Trial registration ClinicalTrials.gov Identifier: NCT03579680, First Posted July 6, 2018.
- Subjects :
- Male
Urologists
Pilot Projects
Health informatics
Health administration
Androgen deprivation therapy
Prostate cancer
Study Protocol
0302 clinical medicine
Discrete choice
Clinical Protocols
Behavior change
Stakeholder
030212 general & internal medicine
Practice Patterns, Physicians'
Chemical castration
lcsh:R5-920
Health Policy
Multimethodology
Health services research
Patient Preference
General Medicine
3. Good health
United States Department of Veterans Affairs
Research Design
030220 oncology & carcinogenesis
Androgen deprivation therapy (ADT)
De-implementation
lcsh:Medicine (General)
medicine.medical_specialty
Clinical Decision-Making
Health Informatics
Intervention
Choosing wisely
03 medical and health sciences
medicine
Humans
Medical physics
Castration
Formulary
Formulary restriction
Implementation Science
business.industry
Public Health, Environmental and Occupational Health
Prostatic Neoplasms
Androgen Antagonists
medicine.disease
United States
Low value care
business
Decision-making
Subjects
Details
- ISSN :
- 17485908
- Volume :
- 13
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Implementation science : IS
- Accession number :
- edsair.doi.dedup.....c6827ee545513e4addda894a5e98a76b